The London Migraine Clinic

Hi there - I am back again after a couple of months away from the forum (but unfortunately not away from MAV!).

I’m just 4 days into my 3rd major MAV bout of this year - first was around March, then one around June/July, and now this one. I’m pretty sure they have all been stress-triggered. A holiday in Sardinia worked wonders for the summer bout but now my kids are driving me bonkers and work’s crappy again, and the weather’s turned bad. To top it off it’s the Saturday after Guy Fawkes’ and there’s fireworks going off outside my house every 2 seconds!

However, I’m was very excited to see the stuff uploaded by Scott from Nick Silver, and have read the .pdf and listened to a bit of the audio thing. I remember this guy from when I worked at Queen Square years ago. It’s a pity he’s moved up North and isn’t still in London (for me anyway, nice if u live up north!). I was interested to hear about the link with restless legs syndrome which i was ‘diagnosed’ with once.

Anyway, the main reason I’m posting is that had my 6 monthly review with my Neuro-otology Consultant (Dr Bamiou) in the nice new posh offices at Queen Square (smell of fresh paint set me off a bit as did the sight of workmen installing a brand new rotating chair :lol: !). She thinks it’s time we tried some different migraine meds, and told me that the balance clinic is teaming up with the London Migraine Clinic to do some joint consultations and I’m going to be one of the first joint patients. This will be in February next year.

Has anyone else here in UK been referred to this Clinic? (The London Migraine Clinic that is.) I went in 1991 (b4 MAV was invented :!: ) and they diagnosed me (wrongly, but the nearest thing available way back then) with BAM. I had a look on their website recently and I don’t think MAV featured. Dr Bamiou was quite excited that MAV’s getting into the ICHD-III. I’m going to go along armed with the Nick Silver PDF.

Also, has anyone checked out MAV on Wiki recently and seen this right near the top:

A 2010 report from the University of British Columbia published in the journal Headache said that it “… is emerging as a popular diagnosis for patients with recurrent vertigo. However, in view of our current understanding of both migraine and vertigo, ‘migraine associated vertigo,’ in contrast to basilar artery migraine, is neither clinically nor biologically plausible as a migraine variant.”

The reference for this (rather unhelpful?) paper is:
Phillips, J., Longridge, N., Mallinson, A. and Robinson, G. (2010), Views and Perspectives: Migraine and Vertigo: A Marriage of Convenience?. Headache: The Journal of Head and Face Pain, 50: 1362–1365. doi: 10.1111/j.1526-4610.2010.01745.x

does anyone have access to the full text and if so can they upload it here? I want all sides of the story!!!

DizzyIzzy xx

Hi Dizzyizzy,

Thanks for the very informative update as always. You’re always a great source of information.

I’m really surprised by that article. I haven’t seen it or heard of anyone saying this lately – and frankly don’t believe it but I’ll dig out the full article and post it here. We better have a look at this author’s argument and evidence.

Very exciting to hear about the two clinics coming together as a united force for treating this junk! Hope you pull out of the current dive quickly.

Scott

Dizzyizzy,

There’s a couple of good articles in this edition of Headache actually (I’ll add later) but here’s the article you requested which also appears on Medscape.

Wow - ta Scott for the speedy reply and uploading of that paper - but then it is tomorrow down under already!

Well, it seems to be saying that MAV is just a ‘catch-all’ for ‘a heterogeneous group including patients with evolving or “as yet unknown” vestibular pathology in the context of our currently poor understanding of many vestibular disorders’.

Unfortunately it appears to me that this may be throwing the baby (migraine) out with the bathwater. I know many people on here don’t get the pain bit of the migraine, and I don’t always either, but Christ when I do get the pain I do get the pain and it’s definitely a type of migraine and it IS intrinsically connected with the dizzy bit. Also, how do they explain the sensitivity to light etc. we get if it’s confined to a ‘vestibular’ pathology?

I don’t really feel the paper has anything particularly helpful or valid to add - I think it’s just urging caution, and I don’t feel it undermines what we believe here. But I think I’ll take it along to my next review to see what the doc says (she’s gonna love me!).

D-I

Hi…I visited two migraine clinics in London after my diagnosis with MAV at Queen Square (2007). Went to one that was at Queen Square in 2008 - part of the National . They changed the diagnosis to BAM…God knows why as I had none of the classic symptoms (no vomiting, passing out etc). My neurotologist at the National disputed the diagnosis about 3 months later. I also self-referred to the Migraine Clinic in London. They were great…but could add absolutely nothing to my diagnosis or suggest anything that I had not already tried/been prescribed etc.

If it is of any interest/comfort I now suffer rarely with the weirdness of MAV…if indeed it was ever MAV. :? As my symptoms started when I was 47 when I had already been told that I was menopausal (I wasn’t: but I was peri-menopausal and hormones were chaotic to say the least), I believe that the whole episode is to do with hormone upheaval and the menopause rather than a 3 year migraine. Maybe the hormones kicked off another phase of migraine pattern for a while as I certainly had a two day blinder shortly after the initial “zoning out dizziness” in 2007. I did try topiramate and lamotrigine for periods of time but had absolutely no resolution with them, and felt much worse on the former.

The only thing that has “cured” me seems to be time and getting back to normality. Was off work initially for two months but could not afford to take any more time off so went back. Also went back to jogging and exercising more. Diet changes did nothing one way or the other.

Good luck with your quest.

Hi Dizzyizzy

Rosalyn Davies spoke about this combined clinic (not to be confused with "the london migraine clinic"in the city ) at the Migraine action event in London a couple of weeks back in response to a question about where we should be being seen - neuro-otology or neurology (she revealed that 50% of the patients they now see in neurotology get diagnosed with migraine)

Sounds like a good step forward to me, it’s going to be a joint clinic between Rosalyn Davies from neuro- oto and Anish Bahra from the migraine clinic from what I could gather - two for the price of one :slight_smile: Just felt I should pass on a word of warning though - reading between the lines I’d be very careful about turning up armed with the Nick silver PDF at this clinic.

I get the impression that Dr Silver is a lot more progessive in his view of this illness than queen square is and they certainly seem to have “professional difference” about how it should be managed (though it seems that these “non typical” migraine symptoms really are his main area of interest and research and he does describe things in a way that make sense to the sufferer so rightly or wrongly I do give his ideas credence). I saw Dr Bahra after knowing what Dr silver would advise in terms of treatment and quite frankly she didn’t entertain any of his ideas, even caffeine abstinence. When I raised the issue about my restless legs assuming it would influence her choice of medication having listened to Dr Silvers info she had no interest at all and I felt like I may as well have been telling her about my genital thrush for all the relevance it had to her!!

Christ - I know what you mean about the new building though. The lighting in there is absolutely horrendous too - by the time I got into my appointment after an hour of sitting waiting in shiny floor fluorescent lighting hell I was a wreck!!. Don’t forget your shades for when you get inside :shock:

Will be very interested to know how the new clinic goes, do keep us posted, Hx

Thanks for the advice, dizzyblonde - I won’t be spouting too much Nick Silver then! Interesting he did his registrar training at Queen Square - probably that’s why he left!

D-I x